Psychiatric and psychotherapeutic recommendations for long/post-COVID and ME/CFS: a narrative review of international guidelines 2026 Kaya et al

[Andy]

Background: Long/post-COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are often accompanied by fatigue, cognitive impairments and psychological symptoms. Psychiatric and psychotherapeutic care is challenged by unclear evidence, symptomatic overlaps, and controversial treatment recommendations.

Objective: Presentation and comparison of psychiatric and psychotherapeutic recommendations in relevant international and national guidelines on long/post-COVID and ME/CFS, focusing on psychotherapy and psychopharmacotherapy.

Methods: A narrative review was conducted. National and international guidelines focusing on ME/CFS and long/post-COVID published between 2020 and 2025, particularly by the WHO, AWMF, NICE, CDC and IQWiG, were included. The selected guidelines were analyzed in terms of key aspects.

Results: Psychiatric pharmacotherapy is recommended only for comorbid disorders. Psychotherapeutic interventions are mostly recommended as supportive in the guidelines. Activating treatment approaches, such as graded exercise therapy (GET) are generally viewed critically in connection with postexertional malaise (PEM), whereas for patients without PEM, several guidelines explicitly endorse moderate, individually adapted activation. Pacing strategies are highlighted across guidelines as a central concept of activity management.

Discussion: Psychiatric and psychotherapeutic interventions in long/post-COVID and ME/CFS are supportive but not causal treatments. Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model. There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.

Open access (in German)

 

[Utsikt]

Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model.

It seems like they read the guidelines but didn’t understand the processes that created them. There is no evidence that ME/CFS should be managed biopsychosocially.

There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.

We’ve already done that. If you bothered reading the research you would have known it failed every single time, or was of so low quality that it’s useless.

 

[Sean]

Two steps forward, one step back.

They are slowly coming around, but it is going to be a tortuous, prolonged, and probably only ever partial admission and acceptance on their part.

 

[bobbler]

Two steps forward, one step back.

They are slowly coming around, but it is going to be a tortuous, prolonged, and probably only ever partial admission and acceptance on their part.

Nah I can’t be sure uts a step forward re the psych ideas…. it’s the perpetuates symptoms even if it’s not the initial cause stuff isn’t it? Ie not supportive in the sense of ‘we know what you are going through so you want to talk about the frustrations or deal with grief or whatnot’

But a believe you might feel less pain if you think about it less type ‘supportive’ still sliding under that parsing of the term?

And they only use the line about ‘wasn’t original cause’ to reduce the weight of proof that would be required from them that they think ‘just inferring it’s the cause but using the term perpetuate’ gives them as wiggle room?